NCLEX Review Guide: Bleeding During Pregnancy

Spontaneous Abortion (Miscarriage)

• Threatened abortion: Vaginal bleeding with closed cervix and no passage of products of conception - pregnancy may continue normally.
• Inevitable abortion: Cervical dilation occurs with bleeding, making pregnancy loss unavoidable.
• Incomplete abortion: Partial expulsion of products of conception with continued bleeding and cramping.
• Complete abortion: All products of conception expelled, bleeding decreases, and cervix closes.

Ectopic Pregnancy

• Implantation occurs outside the uterus, most commonly in the fallopian tube (95%).
• Classic triad: amenorrhea, abdominal pain, and vaginal bleeding - but may not always be present together.
• Risk factors include previous ectopic pregnancy, PID, tubal surgery, and assisted reproductive technology.

Placenta Previa

• Placental implantation in the lower uterine segment, partially or completely covering the cervical os.
• Painless, bright red bleeding that may be intermittent and increase in severity.
• Diagnosed via ultrasound - never perform vaginal exam if placenta previa suspected.

Abruptio Placentae (Placental Abruption)

• Premature separation of normally implanted placenta from uterine wall before delivery.
• Painful, dark red bleeding with rigid, board-like uterus and constant abdominal pain.
• May have concealed bleeding with no visible vaginal bleeding but signs of shock.

Priority Nursing Actions

1. Assess and monitor vital signs, including orthostatic changes
2. Obtain IV access with large-bore catheter (18-gauge or larger)
3. Monitor fetal heart rate continuously if viable pregnancy
4. Assess amount and characteristics of bleeding (count pads, weigh if necessary)
5. Position patient on left side to promote uteroplacental circulation
6. Prepare for possible blood transfusion - type and crossmatch